PDLLA in combination therapy with radiofrequency for acne scars

AUTHOR:

Dr Krzysztof Cudzik, PhD

Specialist in internal medicine, aesthetic medicine doctor

Radiofrequency today is far more than a classic thermolifting technique – it has become an effective stimulatory method, especially in combination therapies. Its combination with poly-D,L-lactic acid (PDLLA) opens up new possibilities in aesthetic medicine, offering comprehensive solutions for a wide range of skin concerns. The RF Combo Jector device stands out on the market as the only system enabling the simultaneous delivery of poly-D,L-lactic acid with radiofrequency. This solution proves effective not only in skin revitalization and firming treatments but also in the reduction of acne scars.

Acne scars represent a challenging aesthetic concern that requires complex, combined therapies. Poly-D,L-lactic acid (PDLLA)—the main component of hybrid collagen stimulators such as Juvelook and Lenisna—performs exceptionally well in this area. Its effectiveness is based on multiple mechanisms of action confirmed by studies, including stimulation of collagen and elastin production through adipocyte proliferation from adipose-derived stem cells, increased adipose tissue volume, protection against UV radiation, skin brightening, enhanced angiogenesis and neovascularization, as well as antioxidant and anti-inflammatory effects. I also observe these outcomes in my own patients. PDLLA is particularly useful in treating acne scars, which often have a vascular and inflammatory component, and therefore require a comprehensive approach.

Evidence-based results

In my opinion, poly-L-lactic acid demonstrates exceptional versatility when combined with other technologies, such as radiofrequency or lasers—significantly greater than other substances used in skin stimulation. PDLLA is also the only substance studied for simultaneous administration with radiofrequency.

A study conducted in Korea* on 42 patients with atrophic acne scars showed an improvement of 36.99% according to the ECCA scale and 79.65% according to the VAS scale after a series of three RF treatments combined with Juvelook—a hybrid of poly-D,L-lactic acid (42.5 mg) and non-cross-linked hyaluronic acid (7.5 mg). Juvelook is the only poly-L-lactic acid designed for direct injection into the dermis.

Histopathological examinations performed after five months demonstrated PDLLA biodegradation along with an increase in both the number and thickness of collagen and elastic fibers—without side effects. Importantly, the results indicate that RF enhances the stimulatory effect of PDLLA through both mechanical and thermal mechanisms, supporting regeneration and collagen synthesis.

RF Combo Jector

As one of the first physicians in Poland, I had the opportunity to use this innovative device, which has now become one of the most frequently used technologies in our Cud-Med clinic. RF Combo Jector combines microneedle radiofrequency with injection mesotherapy, allowing product delivery at a depth of 0.2–5 mm with a single puncture. The depth is selected individually depending on the treatment goal—for example, in skin revitalization I typically use 1.6 mm on the forehead and 1.8 mm on the cheeks; in scar treatment, the depth is adjusted to the scar type.

I most often use poly-D,L-lactic acid for the following indications:

• reduction of acne scars (Juvelook),
• skin revitalization and smoothing of fine wrinkles (Juvelook),
• biostimulation and skin firming after the age of 40–45 (Juvelook or, in more advanced aging cases, Lenisna).

It is worth emphasizing that the device is wireless and compact, which enhances comfort during use. RF Combo Jector ensures precise delivery of the product at the appropriate skin depth—something that can be difficult with manual techniques—making treatments both effective and safe. Thanks to its vacuum (suction) function, the risk of nodules or granulomas—possible complications of improper poly-L-lactic acid injection—is reduced. Additionally, treatments are nearly painless for patients, although local anesthesia can be used to improve comfort.

The device operates in multiple modes—with or without radiofrequency, with product delivery or as standalone microneedle RF. I also use it for administering polynucleotides, non-cross-linked hyaluronic acid, and amino acids, utilizing its mesotherapy gun function. For dual stimulation in one session—needle mesotherapy combined with RF—the device can be used exclusively with Juvelook.

RF Combo Jector can also operate in continuous mode without product delivery, which is particularly effective for treating ice pick scars. The procedure can also be performed as a standalone therapy—so-called “vacuum mesotherapy.” It is comfortable, bruising is rare, and redness subsides within a few hours.

Scars – a challenging aesthetic concern

I use poly-D,L-lactic acid combined with RF to treat various types of acne scars:

• Ice pick scars – narrow and deep, with a base attached to deeper skin layers; difficult to treat due to technical challenges in subcision. Pre-treatment with high-concentration TCA can help “soften” them and facilitate stimulation.
• Boxcar scars – sharply defined edges and a flat base; easier to treat and perform subcision.
• Rolling scars – similar to boxcar scars but with a wavy base, making them more difficult to treat.

Poly-D,L-lactic acid works very well in filling atrophic areas when injected into the base of the scar. I also use it in the treatment of hypertrophic scars and keloids. Juvelook with RF Combo Jector is typically administered in a sequential therapy protocol—treatments are performed every three months, in a series of 2–5 sessions depending on the severity of the condition.

I often incorporate fractional laser therapy as well; in my opinion, Er:YAG laser works best for scars. In a single session, I first perform the laser treatment, followed by injection using RF Combo Jector. In sequential therapy, I use Juvelook with RF or Lenisna in cases of more pronounced skin laxity. One month later, I introduce thermolifting or fractional laser treatments. This approach significantly enhances the effectiveness of PDLLA. Such combination therapies represent a modern, multi-layered strategy for treating acne scars—addressing not only their structure but also improving overall skin quality and regeneration.

Effects of treatments: